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Ovarian teratoma-associated anti-NMDAR encephalitis: a single-institute series of six patients from China.
Arch Gynecol Obstet. 2021 05; 303(5):1283-1294.AG

Abstract

PURPOSE

Ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis is a rare disease with uncertain etiology and pathogenesis. The disorder is severe and rare with a great impact on young adults. This study aimed to improve the awareness of the disease from experience in our single center.

METHODS

Between July 2012 and December 2019, six patients with ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis were enrolled in Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University. All patients' data like manifestations, laboratory and radiological data, treatment, and follow-up were reviewed.

RESULTS

Typical psychotic symptoms, memory, and consciousness disorders accompanied by seizures were observed in all patients from this study. All six patients showed positive signals in serum and cerebrospinal fluid samples for N-methyl-D-aspartate receptor and received immunotherapy. Three patients underwent unilateral oophorocystectomy and the other three underwent unilateral oophorectomy through minimally invasive surgeries, including laparoscopic and single-port laparoscopic surgeries. The median follow-up time 24.5 months (range from 6 to 93 months). No death occurred. Two patients had recurrent psychotic symptoms while the left four patients had no mental symptoms or tumor recurrence during postoperative follow-up.

CONCLUSIONS

For patients with clinical manifestations of unexplained acute psychiatric symptoms accompanied by seizures, memory, and consciousness disorders, the possibility of anti-N-methyl-D-aspartate receptor encephalitis should be considered. To confirm the diagnosis, examinations of anti-N-methyl-D-aspartate receptor antibodies need to be completed as early as possible. Immunotherapy and tumor location should be given in time once the diagnosis is defined. We recommended removing the tumor as soon as possible without concerning whether the patient is in the acute phase or not. The surgical procedure should be decided based on pathology, age, fertility desire, and patients' requirements and it should be ensured that tumors are completely removed during operation. Postoperative follow-up is particularly important.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Shanghai Key Laboratory of Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Shanghai Key Laboratory of Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Shanghai Key Laboratory of Assisted Reproduction and Reproductive Genetics, Shanghai, China.Department of Neurology and Institute of Neurology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Pathology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.Department of Obstetrics and Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. diwen163@163.com. Shanghai Key Laboratory of Gynecology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. diwen163@163.com. State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. diwen163@163.com.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33216164

Citation

Yu, Minhua, et al. "Ovarian Teratoma-associated anti-NMDAR Encephalitis: a Single-institute Series of Six Patients From China." Archives of Gynecology and Obstetrics, vol. 303, no. 5, 2021, pp. 1283-1294.
Yu M, Li S, Cheng J, et al. Ovarian teratoma-associated anti-NMDAR encephalitis: a single-institute series of six patients from China. Arch Gynecol Obstet. 2021;303(5):1283-1294.
Yu, M., Li, S., Cheng, J., Zhou, L., Jiang, Z., & Di, W. (2021). Ovarian teratoma-associated anti-NMDAR encephalitis: a single-institute series of six patients from China. Archives of Gynecology and Obstetrics, 303(5), 1283-1294. https://doi.org/10.1007/s00404-020-05861-3
Yu M, et al. Ovarian Teratoma-associated anti-NMDAR Encephalitis: a Single-institute Series of Six Patients From China. Arch Gynecol Obstet. 2021;303(5):1283-1294. PubMed PMID: 33216164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ovarian teratoma-associated anti-NMDAR encephalitis: a single-institute series of six patients from China. AU - Yu,Minhua, AU - Li,Shanji, AU - Cheng,Jie, AU - Zhou,Liche, AU - Jiang,Zhou, AU - Di,Wen, Y1 - 2020/11/20/ PY - 2020/06/28/received PY - 2020/10/26/accepted PY - 2020/11/21/pubmed PY - 2021/5/29/medline PY - 2020/11/20/entrez KW - Anti-NMDAR encephalitis KW - Ovarian teratoma KW - Surgical removal SP - 1283 EP - 1294 JF - Archives of gynecology and obstetrics JO - Arch Gynecol Obstet VL - 303 IS - 5 N2 - PURPOSE: Ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis is a rare disease with uncertain etiology and pathogenesis. The disorder is severe and rare with a great impact on young adults. This study aimed to improve the awareness of the disease from experience in our single center. METHODS: Between July 2012 and December 2019, six patients with ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis were enrolled in Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University. All patients' data like manifestations, laboratory and radiological data, treatment, and follow-up were reviewed. RESULTS: Typical psychotic symptoms, memory, and consciousness disorders accompanied by seizures were observed in all patients from this study. All six patients showed positive signals in serum and cerebrospinal fluid samples for N-methyl-D-aspartate receptor and received immunotherapy. Three patients underwent unilateral oophorocystectomy and the other three underwent unilateral oophorectomy through minimally invasive surgeries, including laparoscopic and single-port laparoscopic surgeries. The median follow-up time 24.5 months (range from 6 to 93 months). No death occurred. Two patients had recurrent psychotic symptoms while the left four patients had no mental symptoms or tumor recurrence during postoperative follow-up. CONCLUSIONS: For patients with clinical manifestations of unexplained acute psychiatric symptoms accompanied by seizures, memory, and consciousness disorders, the possibility of anti-N-methyl-D-aspartate receptor encephalitis should be considered. To confirm the diagnosis, examinations of anti-N-methyl-D-aspartate receptor antibodies need to be completed as early as possible. Immunotherapy and tumor location should be given in time once the diagnosis is defined. We recommended removing the tumor as soon as possible without concerning whether the patient is in the acute phase or not. The surgical procedure should be decided based on pathology, age, fertility desire, and patients' requirements and it should be ensured that tumors are completely removed during operation. Postoperative follow-up is particularly important. SN - 1432-0711 UR - https://www.unboundmedicine.com/medline/citation/33216164/Ovarian_teratoma_associated_anti_NMDAR_encephalitis:_a_single_institute_series_of_six_patients_from_China_ L2 - https://dx.doi.org/10.1007/s00404-020-05861-3 DB - PRIME DP - Unbound Medicine ER -